Summary:
This 2024 randomized controlled trial—the gold standard of research—found that chiropractic care can change how the brain processes information. Adults with chronic low back pain who received four weeks of chiropractic adjustments showed improved brainwave activity, better sleep, less pain, and lower stress levels compared to those receiving usual care alone.

Why it matters:
The study suggests chiropractic care supports healthy brain-body communication, leading to better mood, sleep, and overall wellbeing. By promoting nervous system balance, chiropractic can play an important role in whole-family wellness and advance health equity through safe, non-drug care that supports long-term quality of life.

Haavik H, Niazi IK, Amjad I, Kumari N, Ghani U, Ashfaque M, Rashid U, Navid MS, Kamavuako EN, Pujari AN, Holt K. Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life. Brain Sci. 2024 Nov 7;14(11):1124. doi: 10.3390/brainsci14111124. PMID: 39595887; PMCID: PMC11592102.

Summary:
This 2025 systematic review and meta-analysis—the most comprehensive to date—examined over 120 studies to identify what truly increases the risk for cervical artery dissection (CAD), a rare condition sometimes discussed in relation to chiropractic care. The review found moderate evidence that migraine and a specific genetic variation (MTHFR TT homozygosity) are risk factors. It also found low to very low evidence that hypertension, high cholesterol, connective tissue disorders, or minor trauma might contribute. Importantly, across multiple large studies, cervical spinal manipulative therapy was not found to be a significant risk factor for CAD when compared to visits with primary care physicians.

Why it matters:
This research reinforces that chiropractic adjustments are not associated with increased risk of arterial dissection, countering a long-standing misconception. Instead, the evidence points toward genetic and cardiovascular factors as more plausible causes. By clarifying these risks, the study supports informed, evidence-based communication between chiropractors, patients, and other healthcare providers—promoting safety, trust, and health equity within musculoskeletal care.

Jacobs, W., Wright, D. S., Pohlman, K., Rosenbaum, R., Hutten, B. A., Scholten-Peeters, G. G. M., Haldeman, S., Ket, J. C. F., & Rubinstein, S. M. (2025). Risk factors for cervical artery dissection: A systematic review with meta-analysis. Stroke & Vascular Neurology.

Summary:
This 2024 experimental study tested how spinal manipulation (manual and instrument-assisted) affects pain sensitivity and muscle function in healthy adults. Twenty-nine participants received adjustments at the neck (C1 and C6) and upper back (T4) during separate sessions. Researchers measured pressure pain thresholds (PPTs) and muscle strength before and after each adjustment.

Results showed that chiropractic adjustments increased pain thresholds—meaning participants became less sensitive to pressure—in the region where adjustments were performed. These effects were regional rather than widespread and were similar between manual and instrument-assisted techniques. Muscle strength did not significantly change, suggesting sensory and motor effects occur through separate mechanisms.

Why it matters:
This study supports the idea that chiropractic adjustments can locally reduce pain sensitivity by influencing how the nervous system processes sensory input. These findings help clarify how adjustments may ease discomfort and restore function, offering a deeper understanding of the neurological mechanisms behind spinal care that extend beyond symptom relief.

Gevers-Montoro, C., Deldar, Z., & Ortega-De Mues, A. (2024). Regional Sensorimotor Effects of Chiropractic Spinal Manipulation: Preliminary Results From an Experimental Study. Journal of Manipulative and Physiological Therapeutics, 46(5–9), 280–293.

Summary:
This randomized controlled trial followed 185 infants with colic for two weeks to test whether chiropractic care could reduce crying time. Babies who received gentle chiropractic adjustments cried about 30 minutes less per day than those who didn’t, and a larger number of parents reported a meaningful one-hour-or-more reduction in crying. No safety concerns were found.

Why it matters:
Even small reductions in crying can make a big difference for exhausted families. This study suggests that chiropractic care may help some infants regulate their nervous systems and settle more easily—providing a safe, non-drug option that supports calmer babies, lower parental stress, and better sleep for the whole family.

Chiropractic connection:
Gentle, age-appropriate adjustments used in pediatric chiropractic share similar goals with this study’s approach—improving comfort, function, and family wellbeing through hands-on care that respects how babies develop and self-regulate.

Holm, L. V., Jarbøl, D. E., Christensen, H. W., Søndergaard, J., & Hestbæk, L. (2021). The effect of chiropractic care on infantile colic: Results from a single-blind randomised controlled trial. Chiropractic & Manual Therapies, 29, 15.

Summary:
This randomized controlled trial examined whether adding pediatric integrative manual therapy (PIMT) to caregiver education could improve neck motion in infants with positional plagiocephaly (a flat or asymmetrical head shape). Thirty-four infants under 28 weeks old were assigned to either 10 weeks of caregiver education alone or caregiver education plus PIMT. The manual therapy included gentle mobilization of the upper cervical spine (occiput, atlas, and axis) using light touch and myofascial release techniques.

Infants who received manual therapy showed a significant improvement in neck rotation—about five times greater than the control group (an average increase of 29.7° vs. 6.1°). Both groups showed similar progress in motor development, and no adverse events were reported

Why it matters:
This study provides strong evidence that gentle manual therapy can safely restore neck mobility in babies with flat-head syndrome, a common condition often linked to limited neck rotation or torticollis. Improved range of motion may help babies achieve better symmetry, comfort, and developmental milestones.

Chiropractic connection:
The techniques used mirror those found in pediatric chiropractic care, focusing on gentle, non-forceful mobilization to restore movement and balance in the upper cervical spine. These results reinforce chiropractic’s role in early intervention for infants with head asymmetry or movement restriction, supporting whole-family wellness through natural, hands-on care.

Pastor-Pons, I., Hidalgo-García, C., Lucha-López, M. O., Barrau-Lalmolda, M., Rodes-Pastor, I., Rodríguez-Fernández, Á. L., & Tricás-Moreno, J. M. (2021). Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: A randomized controlled trial. Italian Journal of Pediatrics, 47(41)

Summary:
This 2017 randomized clinical trial compared the effects of manual spinal manipulation (MSM) and instrumental spinal manipulation (ISM) using the Activator V device on the hemodynamics of the vertebral (VA) and internal carotid arteries (ICA) in adults with chronic nonspecific neck pain (NNP). Thirty participants were divided into two groups (MSM vs. ISM), and Doppler ultrasound was used to measure arterial blood flow velocity, resistive index, and volume flow before and after upper cervical manipulation.

The study found no significant differences within or between groups in VA or ICA blood flow parameters before and after manipulation, except for a small change in ipsilateral ICA peak systolic velocity that was not clinically meaningful. Overall, both MSM and ISM did not alter vertebral or carotid artery hemodynamics, suggesting that these common chiropractic techniques do not produce adverse circulatory effects in the cervical arteries.

Why it matters:
This study provides direct, ultrasound-based evidence that cervical spinal manipulations—whether performed manually or with an instrument—do not negatively impact blood flow in the vertebral or carotid arteries. These findings add to the growing body of literature demonstrating the vascular safety of chiropractic cervical adjustments, countering misconceptions that such procedures endanger the arteries supplying the brain. The results also support the inclusion of both manual and instrument-assisted techniques in evidence-based management of chronic nonspecific neck pain, aligning with established clinical practice guidelines.

Citation:
Kurt, B., Cengiz, D. K., Gungor, K., Albayrak, M. H., & Yildiz, S. (2017). The effect of manual and instrumental spinal manipulation on vertebral and internal carotid artery hemodynamics in patients with chronic nonspecific neck pain. Journal of Manipulative and Physiological Therapeutics, 40(8), 608–617.

Summary:
This 2025 retrospective cohort study used the TriNetX network to compare opioid-naïve adults with a new episode of low back pain (with/without sciatica) who received chiropractor-delivered spinal manipulative therapy (SMT) versus matched patients prescribed ibuprofen at an ambulatory visit. After 1:1 propensity matching (n=24,993 per cohort), SMT was associated with a significantly lower two-year incidence of opioid use disorder (OUD) 0.24% vs 1.51% (RR = 0.20; 95% CI, 0.15–0.28), as well as lower long-term opioid use 0.42% vs 1.85% (RR = 0.23) and lower odds of receiving any opioid prescription 30.96% vs 45.00% (RR = 0.69). SMT recipients also had fewer opioid prescriptions on average (mean 1.0 vs 2.1). PMC

Why it matters:
For new, nonserious low back pain, starting with SMT—an evidence-based, first-line, nonpharmacologic option—is associated with substantially lower downstream opioid exposure and OUD risk compared with an active comparator (ibuprofen). These real-world findings support guideline-concordant care pathways that prioritize conservative, non-drug management and may help reduce opioid-related harms. PMC

Citation:
Trager, R. J., Cupler, Z. A., Gliedt, J. A., Fischer, R. A., Srinivasan, R., & Thorfinnson, H. (2025). Association between spinal manipulative therapy for low back pain with or without sciatica and opioid use disorder: A retrospective cohort study. Health Science Reports. https://doi.org/10.1002/hsr2.71267

Summary:
This 2025 Medicare claims–based retrospective cohort study (n = 291,604; adults 65–99 with a new 2019 neck-pain episode) compared three initial care pathways: (1) chiropractic manipulative therapy (CMT; no primary-care visit), (2) primary care with prescription drug therapy (PDT; analgesic within 7 days), and (3) primary care only (PCO; no chiropractic, no analgesic). Over 24 months, using Poisson regression with robust SEs and inverse-propensity weighting, CMT was associated with lower rates of adverse outcomes versus medical care: 20% lower than PDT and 14% lower than PCO, while PDT had a 6% higher adverse-event rate than PCO. Outcomes included adverse drug events, vertebrobasilar insufficiency, stroke, spinal injury, and other selected complications. PubMed

Why it matters:
For older adults with new neck pain, starting care with chiropractic manipulation was linked to fewer serious complications than beginning in primary care—especially when medications were involved. These real-world data support guideline-consistent, nonpharmacologic first-line management and suggest that minimizing early analgesic exposure may improve safety in this high-risk population.

Citation:
Whedon, J. M., Anderson, B., Mackenzie, T. A., Grout, L., Moonaz, S., Lurie, J. D., & Haldeman, S. (2025). Observational Study of the Safety of Chiropractic vs Medical Care Among Older Adults With Neck Pain. Journal of Manipulative and Physiological Therapeutics. Advance online publication. https://doi.org/10.1016/j.jmpt.2025.07.002.

Summary:
This randomized controlled trial evaluated whether lumbar spinal manipulation (LSM) could improve pain and quadriceps strength in adults with patellofemoral pain syndrome (PFPS). Thirty participants were randomly assigned to receive either true lumbar manipulation or a sham manual contact twice weekly for four weeks (8 sessions total).

The manipulation group experienced significantly greater improvements in pressure pain threshold across all quadriceps sites and showed a larger increase in quadriceps strength than the placebo group. Both groups improved in balance and proprioception, but there were no between-group differences for those outcomes.

The authors suggest that spinal manipulation may work by modulating nociception, reducing arthrogenic muscle inhibition, and enhancing neuromuscular drive through L2–L4 segmental pathways—all relevant to quadriceps activation. No adverse events were reported. PFP Syndrome

Why it matters:
PFPS is often influenced by altered neuromuscular control and pain amplification, not just knee mechanics. This study shows that addressing the lumbar spine can meaningfully improve pain sensitivity and muscle output, supporting a whole-kinetic-chain approach.

Chiropractic connection:
The intervention used, HVLA manipulation at L2–L4, is consistent with common chiropractic protocols. This trial reinforces chiropractic’s role in adjunctive management of knee pain, especially when quadriceps inhibition or central sensitization are contributing factors.

Won, J., & Lee, Y. (2025). Effects of lumbar spinal manipulation on pain and quadriceps strength in patellofemoral pain syndrome: A randomized controlled trial. Complementary Therapies in Medicine, 95, 103301. https://doi.org/10.1016/j.ctim.2025.103301